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. When implementing interventions at the systems-level of practice, the public health
nurse would:
a. Involve the entire community in solving the health problem.
b. Identify health problems in the community.
c. Change laws, policies, and practices that influence population-based issues.
d. Provide outreach services to populations at risk. - ANSANS: C
Systems-level practice consists of changing laws, policies, and practices that influence
population-based issues.
. Which statement regarding mutations is true?
a. Mutations in the DNA sequence occur on a regular basis.
b. Mutagens are a result of a mutation.
c. Environmental factors can be linked to many mutations.
d. Spontaneous mutations occur because of environmental exposure. - ANSANS: C
A large number of agents are known to cause mutations. These mutations are attributed
to known environmental causes. DNA replication is very accurate, thus, mutations do
not occur on a regular basis. Mutagens are the factors that cause mutations.
Spontaneous mutations occur naturally during DNA replication.
1. A home health case manager is charged with identifying opportunities for health
promotion and illness prevention. The fulfillment of this charge would best be
demonstrated when the case manager:
a. collaborates with a local chaplain to ensure that the spiritual needs of cancer clients
are addressed.
b. refers a new diabetic client to a nutrition counselor for dietary teaching.
c. teaches a school nurse how to care for a client who will be returning to school and will
require new asthma treatments.
d. tracks the immunization status of clients and facilitates access to immunization when
needed. - ANSANS: D
Case management involves assessment—in this case, screening—and arrangement for
delivery of services. Primary prevention includes case management to identify at-risk
clients and arrange for services to prevent disease. Through nurse management
activities, general community deficiencies in the quality or quantity of health services are
often discovered. Case management activities with individual clients and families will
reveal the broader picture of health services in and health status of the community.
Community assessment, policy development, and assurance activities that frame the
core functions of public health actions are often the logical next step in the nurse case
manager's practice to intervene at the community level to make changes. Therefore, the
core components of case management and the nursing process are complementary.
The nursing process function of assessment is complementary to the case management
process function of case finding and includes such activities as applying screening tools
according to program goals and objectives.
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1. A nurse is assigned to provide community outreach to a small town that was partially
destroyed by a tornado 3 years earlier and has been rebuilt. The first client is a family
who lost their home and their best friend in the tornado. The best intervention would
include:
a. assessment of the family's home environment to rule out safety issues.
b. avoidance of discussion of the disaster of 3 years ago.
c. consideration that the family will have worked through the emotional aftermath by
now.
d. support of the family in preparing a personal disaster response plan. - ANSANS: D
The approach of relief activities needs to shift from short-term aid to long-term support.
Promoting individual, family, and community preparedness increases safety in the event
of disaster and can help children and adults feel empowered. This builds on the
resilience of the individual, family, and/or community. Individuals and families still need
to be assessed for indications of mental distress (case finding) and referred to a mental
health professional if the need exists. Open discussions of the family's response to the
slow process of recovery or long-term results of living under adverse conditions can
uncover lingering mental distress or exacerbations of chronic conditions that require
attention. During the initial stages of recovery environmental safety issues should have
been addressed.
1. A nurse performing home hospice case management notes the increasing number of
hospice clients who lack caregivers in the home environment. The nurse identifies the
potential need for a hospice house facility to meet the needs of these clients. The case
management process frequently reveals larger picture issues such as which of the
following?(Select all that apply.)
a. Community cost concerns
b. Community conflict resolution skills
c. Community satisfaction
d. Community weaknesses in quality of services
e. Community weaknesses in quantity of services - ANSANS: D, E
Case management activities with individual clients and families very often reveal the
larger picture of health services and health status of a community. General community
weaknesses in the quality and quantity of services often are discovered. The nurse can
then intervene at the community level to initiate changes. In this case, the nurse
identified a deficiency in the quality of hospice services to individuals who did not have a
caregiver in the home environment and the parallel concern of the lack of hospice-
related facilities to meet the needs of these clients to achieve a quality dying process.
1. A nurse volunteering at a local homeless shelter notes that many of the clients have
acute and chronic illnesses and are in need of primary health care services. The most
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effective strategy to consider when networking with homeless individuals, families, or
populations is to:
a. form a community partnership to establish a clinic for homeless persons.
b. create a trusting environment and establish a therapeutic relationship.
c. collaborate with the local United Way to obtain funding for primary care services.
d. dialogue with local clergy to address the unmet primary care need for homeless
persons. - ANSANS: B
Nurses need to be able to work with poor and homeless clients to promote, maintain,
and restore health. Nurses must be prepared to look at the whole picture: the person,
the family, and the community interacting with the environment. In working with the
homeless, it is important to create a trusting environment. Trust is essential to the
development of a therapeutic relationship with poor or homeless persons. Many clients
and families have been disappointed by interactions with health care and social
systems. They are now mistrustful and see little hope for change. Establishing a trusting
relationship lays the foundation for a more comprehensive assessment of clients'
perception of their health care needs and a determination of factors that may contribute
to their current health status issues.
1. A school nurse is teaching a class of sophomores about the relationship between the
risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to
include is:
a. all STDs are easily preventable with consistent condom use.
b. once a young woman is pregnant, she is no longer at risk for most STDs.
c. STDs are most likely to be transmitted during a student's initial sexual encounter.
d. use of alcohol and drugs makes a student more likely to make decisions that result in
exposure to and infection with STDs. - ANSANS: D
Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions
and impair judgment about engaging in risky behaviors. Addictions to drugs may cause
individuals to acquire the drug or money to purchase the drug by performing sexual
favors. This increases both the frequency of sexual contacts and the chances of
contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable
through condom use. The challenge of preventing human papillomavirus (HPV)
infection (genital warts) is that condoms do not necessarily prevent infection because
warts may grow in areas that barriers such as condoms do not cover and skin-to-skin
contact may occur
1. Advantages of community health program planning include ensuring that available
resources are used to meet the needs of the population and:
a. applying for grants.
b. identifying clients and soliciting board members' support.
c. identifying resources, activities, and needs.
d. increasing the visibility of the program. - ANSANS: C
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Community health program planning is population focused and puts the well-being of
the public above private interests. Systematic planning for meeting the needs of
populations in a community has benefits for clients, nurses, employing agencies, and
the community. It ensures that available resources are used to address the actual
needs of people in the community, focuses attention on what the organization and
health provider are attempting to do for clients, identifies resources and activities that
are needed to meet the objectives of client services, reduces role ambiguity by giving
responsibility to specific providers to meet program objectives, reduces uncertainty
within the program environment, increases the ability of the provider and agency to
cope with the external environment and anticipate events, allows for quality decision
making, and provides better control over the actual program results. Identifying clients,
soliciting board support, applying for grants, and promoting the actual program are
steps in the implementation phase of program management.
1. Effects of homelessness on health care outcomes can be devastating and may
include which of the following? (Select all that apply.)
a. Higher incidence of acute and chronic disease
b. Higher risk of physical trauma
c. Crisis-oriented health care, usually in emergency departments
d. Reduced eligibility for entitlement/assistance programs
e. Lack of awareness of care options - ANSANS: A, B, C, E
Homelessness is correlated with poor health outcomes. The incidence of acute and
chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is
significantly higher among homeless persons. Although homeless persons are at higher
risk for physiological problems, they have greater difficulty accessing health care
services. Health care is usually crisis oriented and sought in emergency departments,
and those who access health care have a hard time following prescribed regimens.
Health problems of homeless clients are often directly related to poor preventive health
care services. In addition to facing challenges related to self-care, homeless people
usually give lower priority to health promotion and health maintenance than to obtaining
food and shelter. They spend most of their time trying to survive. Just getting money to
buy food is a major challenge. Although some homeless persons are eligible for
entitlement programs such as Temporary Assistance for Needy Families (TANF),
Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell
plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to
treatment include lack of awareness of treatment options, lack of available space in
treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive
attitudes of service providers, and lack of coordinated services.
1. In 1988, the Institute of Medicine (IOM) published a report on the future of public
health and its mission that defined public health as:
a. what public-private partnerships do to treat vulnerable populations.
b. what the government does to ensure that vital programs are in place.